Effect of dehydroepiandrosterone supplementation on the embryo quality and follicular fluid markers in patients with diminished ovarian reserve

Abstract

Objective To examine the effect of the dehydroepndrosterone (DHEA) supplementation on the embryo quality and the levels of follicular fluid markers in diminished ovarian reserve (DOR) patients for in vitro fertilization (IVF). Methods This was a prospective randomization controlled trial. One hundred and sixteen DOR patients were randomized 1︰1 into two groups. The DHEA group (n=58) received DHEA 25 mg/times, tid for 12 weeks and control group (n=58) entered the IVF cycle directly. IVF parameters including the number of retrieved oocytes, matured oocytes, cleaved embryos, available embryos, good-quality embryos and clinical pregnancy rate were compared between the two groups. Follicular fluid anti-Mullerian hormone (AMH), insulin growth factor (IGF)-1 were tested by ELISA and the expression levels of bone morphogenetic protein (BMP)-15 and growth differentiation factor (GDF)-9 were tested by Western blotting assay. Results The number of available embryos (2.0±1.3) and good-quality embryos (1.4±1.1) were significantly increased in DHEA group than in control group (1.5±1.2, P=0.018; 1.0±1.0, P=0.033). AMH level in follicular fluid [(2.83±1.14) μg/L], IGF-1 concentration [(94.02±38.28) μg/L] were significantly higher in DHEA group than in the control [(1.37±0.55) μg/L, P=0.000; (74.03±25.46) μg/L, P=0.004]. Western blotting showed the expression levels of BMP-15 were higher in DHEA group (P<0.000 1), but GDF-9 was not significantly different (P=0.987). However, the clinical pregnancy rates were also not significant between the two groups (P=0.223). Conclusion In women with DOR undergoing treatment with IVF, pre-treatment with DHEA could increase the number of good-quality embryos, which may be associated with the increase level of AMH, IGF-1 and BMP-15 in follicular fluid. Key words: Dehydroepiandrosterone (DHEA); Diminished ovarian reserve (DOR); In vitro fertilization (IVF); Bone morphogenetic protein (BMP)-15